RU2494670C2 - Method of correcting fine motor skills with application of sensor gloves - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, rehabilitation, in particular, of patients with hand paresis. Patient's hand is placed and fixed in device in form of sensor glove; sensitive and current-conducting elements are placed and fixed relative to device. Device is switched to computer; computer game programme is downloaded and started. Sensor glove is used as manipulator in such a way that patients makes active movements of flexion-extension of hand and fingers, providing in this way corresponding specified movements of computer game object on monitor screen and causing by this activation of sensitive elements and their registration in computer. Course of correction sessions constitutes 28-30, 1-2 times per day 5 days per week. Duration of one session is determined by severity of patient's general state and constitutes in average 30-40 minutes.

EFFECT: method ensures extension of functional possibilities, effective rehabilitation in case of motor disorders due to objective computer analysis of sensomotor processes with smaller time consumption, as well as possibility of rehabilitation of motor function of hand with participation of patient with impaired nervous system in rehabilitation process.

2 cl, 1 ex, 1 tbl

Description

The invention relates to medicine and neuropsychology, in particular to computer technology for the rehabilitation of fine motor skills of the hand and related neuropsychological characteristics of a person.

It is known that the development of hand motor skills in humans is directly related to the development of interhemispheric specialization and interhemispheric interaction and, as a result, the development of speech, memory, attention and other cognitive functions.

An analysis of the prior art shows that certain elements of the diagnosis of fine motor skills of the hand are included as part of the methods for assessing and monitoring the characteristics of a person’s neuropsychological state. The amount of information about the state of fine motor skills of the hand obtained during such studies, determined by the specific task for its implementation, is usually limited.

A known method of formation and correction of motor plastics (RF patent No. 2234728, IPC 7 G06F 17/00, G06F 159: 00, G06F 3/03, 08/20/2004), in which by obtaining information during the execution of movement using peripheral sensors, processing and data analysis from these sensors by means of computer technology in the so-called “real time” mode, storing and outputting - the result of the analysis, form the required motor action as an exemplary (reference), create its mathematical or electrical model, formalize it in the form of a mathematical software for the microcomputer and mastering this motor action is aware of the required motor structure, associating and measuring it with the reference (exemplary) motor action and, therefore, with the exemplary spatial position of the articular joints, current information about which is obtained from the corresponding peripheral sensors, includes muscle groups of the corresponding articular joints in active work, iteratively approaching the correct execution of the motor action, and consolidates the latter in Processes repetitions, quickly checking the correctness of their performance.

The disadvantages of the method and device include the impossibility of developing coordinated movements with lesions of the upper limb.

Closest to the proposed method is the rehabilitation of patients with paresis of the upper limb (RF patent No. 2114594, IPC 6 A61H 1/00, op. 10.07.1998), which includes placing the patient’s hand in a device containing a lodgement with a counterweight, and performing active movements, characterized in that the device is connected to a computer, set the game program, which in the first sessions includes the execution of 100-150 movements for 15-20 minutes, then the program is complicated and in 3-4 sessions increase the number of movements to 200-300 and the duration to 45-60 min, treatment with remains from 20-30 sessions for 45 days.

The use of computer technology reduces the role of the subjective factor.

But at the same time, the well-known technical solutions have inherent disadvantages in the complexity of the devices necessary for the implementation of the known methods and limited capabilities due to purely mechanical training or rehabilitation of the patient’s hands.

The present invention is based on the solution of the problem of increasing the effectiveness of treatment by providing the patient with the possibility of developing positive motivation when performing self-regulation procedures, shortening the treatment time for patients and reducing the medical load.

The technical result in solving this problem is to expand the functionality of the proposed method, which leads to a reduction in the rehabilitation of patients with central nervous system damage and motor impairment.

This is achieved due to the fact that in the known rehabilitation method, including arranging a patient’s hand in a device, connecting the device to a computer, downloading and launching a computer game program, performing a patient active movements for folding-unbending, according to the invention, the patient fixes the device on his hand the form of a shell having a shape close to the shape of a hand; while positioning and fixing relative to the device sensitive and conductive elements; then the patient performs active movements on flexion-extension, causing this to trigger sensing elements; while the movements performed by the patient are recorded in the computer.

The training method is sequentially carried out using a gaming computer program, for example, when the patient turns the wrist to the right.

The procedure for conducting medical procedures using this device.

Depending on the diagnosis and the age of the patient (children, adults), after examination, the doctor selects the most appropriate tactics for conducting functional biocontrol procedures. The patient is explained the general procedure for the procedure and poses a game task.

Initially, the device is connected to a computer, then a computer game program is downloaded and launched. Sensors selected by the physician of physiological parameters are placed on the device in the form of a sensor glove fixed on the patient’s hand, the patient is placed in a comfortable position in front of the monitor and presented with a game situation on the monitor. As the patient learns, he copes with the game task better and better. The patient has an interest (positive motivation) to achieve the greatest result in the game.

The advantage of the proposed method with a basic object is as follows: accelerating the rehabilitation of the development of functional movements in the brush of the affected upper limb.

The advantages of the method are that in the process of working in the “touch glove” device, conditions are created for additional activation of the motor zones of the cortex, game motivation is used, the method is mobile in use, it does not cause an increase in spasticity of the hand, and is possible for patients to use at home on their own.

The method is based on the use of a device of motor activity of the hand using sensory gloves.

The device of motor activity is a specially designed device consisting of a laptop, a touch glove connected to a computer, software for recognizing signals from bend sensors with which the glove is equipped, a specially selected computer game.

The course of remedial classes is 28-30. The routine is 1-2 times a day, 5 days a week. The duration of one lesson is determined by the severity of the general condition of the patient and averages 30-40 minutes.

The criteria for inclusion of patients in the study were:

Patients who underwent stroke with motor impairment in the hand in the degree of moderate and severe paresis in the acute and early recovery period of stroke.

Cerebral stroke

Gender - both sexes

Age 40-65 years old

First stroke

Ashworth score: no more than 2 points

Muscle strength in the hand at least 1 point in the extensors of the fingers

MAS scale in the subheadings Hand movements Hand movements and Advanced Hand activity from 1 to 8 points

Patients who signed informed consent for the study.

The advantages of the developed method are as follows:

- focus on the most difficult to recover violations of the movements of the brush;

- the possibility of conducting outpatient and independent studies with the patient;

- the presence of feedback in the form of a computer game increases the efficiency of restoring brush functions.

The proposed method of restoring the movements of patients with stroke is industrially applicable in the field of practical health care, as it can be reproduced repeatedly without requiring exceptional funds for implementation.

A group of researchers led by prof. S.V. Prokopenko is developing methods for the rehabilitation of patients who, as a result of brain damage, partially lost the ability to complete motor activity.

The method was developed and tested at the Krasnoyarsk Medical Academy. Clinical trials confirm its high efficiency.

An example of using the method of correcting fine motor skills using a sensory glove in the recovery period of a stroke:

Patient R., 59 years old. Diagnosis: The recovery period of acute ischemic cerebrovascular accident (02.06.2010) in the basin of the left middle cerebral artery, with moderate right hemiparesis, pronounced paresis of the hand, mild aphasia. Background: Hypertension of the III degree, risk 4.

From the anamnesis: I fell ill suddenly - 06/02/2010 - in the morning against the background of complete well-being, I felt weakness in my right hand, speech was disturbed, then there was weakness in my right leg, was hospitalized in the city hospital of Anzhero-Sudzhensk, the speech improved during the therapy, I began to move, while maintaining a rough paresis of the right hand. Hospitalized in the Siberian Clinical Center of the city of Krasnoyarsk to undergo a course of neurorehabilitation 10.27.10.

Upon receipt, it was noted:

Complaints, limitation of motor activity in the right limbs, rougher in the right hand, impaired walking function, pain in the right hand. Objective data: Vision is not impaired. Palpebral fissures and pupils without a difference of sides, weakness of the eyeball convention. Asymmetry of the right NHS. Positive reflexes of oral automatism on the right. The soft sky is mobile. The pharyngeal reflex is reduced from 2 sides. Tongue deviation to the right. Muscle strength is reduced in the right extremities: in the proximal arm up to 1.5 points, in the hand up to 1 point, the proximal leg up to 3, 5 points, in the foot - 3 points. Muscle tone is easily elevated in the right extremities in a spastic type. Tendon reflexes are enlivened, D> S, positive pyramidal signs: Laska-Jacobson on the right, Babinsky on the right. In the Romberg position - shakiness. Hemiparetic gait.

MRI of the brain - from 07/15/2010 - post-stroke cyst at the level of the basal nuclei on the left. Light mixed subatrophic hydrocephalus

EEG: Light cerebral changes in the bioelectrical activity of the regulatory type brain against the background of LRK dysfunction at the mesencifal level. Focal and paroxysmal activity is not registered.

Echocardiography: Compaction of the aorta, aortic valve, heart cavity is not expanded. LV contractility retained.

Biochemical blood tests: total cholesterol 5.74; LDL cholesterol 3.41; HDL cholesterol 1.76; Atherogenic coefficient 1.32; triglycerides - 0.1.25, urea 4.2 mmol / l, creatinine 67 μmol / l, potassium 4.4; total calcium - 2.3; PTV - 15.6; APTT - 31.00, fibrinogen - 2.94

Zakl. ophthalmologist: hypertensive angiopathy.

The patient received drug therapy, taking into account the standard of management of the recovery period of stroke and existing comorbidities.

The following scales were used to study the degree of impairment of the state of the motor and cognitive sphere:

- assessment of neurological status on a scale of stroke NIHSS - 9 points - the average degree of neurological disorders,

- assessment of spasticity on the Ashworth scale - 2-average increase in muscle tone, limb moves easily;

- assessment of the motor capabilities of the right upper limb on the Fugl-Meyer Motor Test-35 scale out of 66 possible points - pronounced paresis,

- assessment of the degree of functional impairment in the hand according to the MAS scale - 2 points out of 6 - severe impairment, a questionnaire on the limitations of legal capacity of the upper extremities DASH - 85.83 - serious disability due to hand weakness.

- assessment of cognitive impairment using MMSE - 26 points - moderate cognitive impairment.

- assessment of cognitive impairment using HDF 7 points - moderate cognitive impairment. Assessment of anxiety and depression using GSTD T = 2, D = 3 normal.

Conducted standard drug therapy taking into account concomitant diseases and rehabilitation using a psychophysiological complex for the rehabilitation of fine brush motility based on a sensory glove, for 20 days 1 time per day, the duration of classes was 30 minutes. During the lesson, the patient was asked to complete the task of a computer game by moving her fingers and the hand of a paralyzed hand, using a touch glove as a manipulator. For the patient, it was important to restore the extension of 2-4 fingers of the right hand, therefore, in the task of moving the object on the screen, these fingers were associated with the activity. Extension of the index - corresponded to the movement of the object on the screen up, extension of the middle - to the movement down, extension of the nameless - to the left, extension of the little finger - to the movement of the object to the right.

As a result of the rehabilitation, a significant improvement in the functions of the right hand was reliably observed, as evidenced by the positive dynamics of most of the scales used in the study - Table. one.

Table 1. The results of the correction of fine brush motility in patient R. using the proposed method. Inspection Nihss Ashworth Fugl-Meyer Motor Test Mas Dash Hrc KSHOP S GSTTD T D one 9 2 35 2 7 26 2 3 2 5 2 52 6 10 29th 2 one

As follows from the data presented, the patient improved motor abilities in the right upper limb, fine kitsi motility, decreased degree of disability associated with paresis of the hand, while there was no increase in the severity of spasticity on the Ashworth scale and there was a slight improvement on the scales for assessing cognitive functions and self-satisfaction with treatment outcomes.

Claims (2)

1. A method for correcting fine motor skills of a brush, including placing a patient’s hand in a device, connecting the device to a computer, downloading and running a computer game program, and performing active movements for bending-unbending, characterized in that the patient’s hand is placed and fixed in the device in the form sensory gloves; sensitive and conductive elements are positioned and fixed relative to the device; in this case, the touch glove is used as a manipulator in such a way that the patient performs active flexion-extension movements of the hand and fingers, thereby ensuring the corresponding predetermined movements of the computer game object on the monitor screen and thereby triggering the sensing elements and their registration in the computer. 2. A method for correcting fine motor skills of a brush according to claim 1, characterized in that the course of corrective exercises is 28-30; routine 1-2 times a day 5 days a week; the duration of one lesson is determined by the severity of the general condition of the patient and averages 30-40 minutes.